Abstract Background/Purpose: Over the past two decades, the incidence of cancers diagnosed among adults younger than age 50 (e.g., early-onset cancer) has risen globally. Emerging evidence indicates these trends span multiple cancer types, disproportionately burdening women, and racially and ethnically minoritized populations. However, population-level estimates of the burden of screen-detectable cancers among younger adults remain poorly characterized, limiting efforts to inform public health strategies. This study aims to quantify the prevalence and distribution of screen-detectable cancers among adults diagnosed before age 50. Methods: We utilized 2022 data from Health Information National Trends Survey-Surveillance, Epidemiology, and End Results (HINTS-SEER), a registry-linked national survey of cancer survivors. Weighted prevalence estimates of cancers survivors among adults aged 18-49 were calculated to describe screen-detectable cancers among adults diagnosed before age 50. Cancer sites were categorized as breast, colorectal, cervical, lung, prostate, and non-melanoma skin. Weighted estimates accounted for complex survey design. Findings were stratified by birth sex, race and ethnicity. Results: The analytic sample included 298 respondents (weighted N ≈ 119,131). Screen-detectable cancers accounted for 60.0% of diagnoses. By site, prevalence estimates were breast (29.0%), non-melanoma skin (16.1%), colorectal (7.2%), prostate (4.3%), lung (2.3%), and cervical (1.0%). Mean age varied by site, from 28.2 years for cervical cancer to 43.0 years for colorectal cancer. The sample was predominantly female (67.6%) and included respondents who were non-Hispanic White (73.6%), Hispanic (13.4%), non-Hispanic Asian (7.6%), non-Hispanic Black (3.2%), and non-Hispanic other (2.2%). Most participants (87.3%) reported at least one first- or second-degree relative with cancer, and one-third (31.6%) reported undergoing genetic testing. Conclusions (Interpretation/Implications): Screen-detectable cancers represent a substantial proportion of early-onset cancers, driven primarily by breast and non-melanoma skin cancers, with meaningful contributions from colorectal, prostate, lung, and cervical cancers. These findings highlight critical opportunities to refine screening initiation ages, improve awareness, and implement risk-based screening strategies for younger populations. Although subgroup estimates were limited by small sample sizes, overall patterns underscore the urgency of targeted prevention and early detection efforts. Registry-linked national surveys such as HINTS-SEER provide essential context to guide policy and resource allocation tin response to the growing burden of early-onset cancers. Citation Format: Gaurav Y. Kulkarni, Matthew Untalan, Wayne R. Lawrence, Ami E. Sedani, Subhankar Chakraborty, Dede K. Teteh-Brooks, Aldenise P. Ewing. Prevalence of screen-detectable cancers among adults aged 18-49 years: Findings from HINTS-SEER [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 916.

BACKGROUND:Studies have demonstrated neighborhood structural inequities are associated with cardiovascular outcomes among breast cancer survivors. We investigated the associations between bias in mortgage lending practices (contemporary redlining and racial lending bias) and cardiovascular outcomes in women with breast cancer. METHODS:Using the SEER (Surveillance, Epidemiology, and End Results)-Medicare database, we identified 51 007 Black and White women diagnosed with breast cancer between 2010 and 2014 with follow-up through 2020. We used Home Mortgage Disclosure Act data to calculate census-tract contemporary redlining index and racial lending bias index, and assessed indices continuously and categorically (low, moderate, or high). We used Cox proportional hazards regression to estimate multivariable-adjusted, cause-specific hazard ratios (HRs) for major adverse cardiovascular events, ischemic heart disease, heart failure, stroke, and cardiovascular death. RESULTS:In the overall population, a 10%-unit increase in redlining was associated with increased risk of major adverse cardiovascular events (HR, 1.04 [95% CI, 1.02-1.06]). Among Black women, those in high redlining neighborhoods had an increased heart failure risk compared with those in low redlining neighborhoods (HR, 1.22 [95% CI, 1.05-1.41]). Similarly, White women in high redlining neighborhoods had an increased risk of ischemic heart disease (HR, 1.23 [95% CI, 1.15-1.30]) and stroke (HR, 1.09 [95% CI, 1.03-1.16]). Black women in high racial lending bias neighborhoods had reduced cardiovascular mortality risk compared with those in low racial lending bias neighborhoods (HR, 0.69 [95% CI, 0.54-0.90]). CONCLUSIONS:We identified associations between contemporary redlining and cardiovascular outcomes among breast cancer survivors. High racial lending bias was associated with reduced cardiovascular mortality risk among Black women. Bias in mortgage lending practices may serve as a structural driver of cardiovascular disparities.

Introduction:Social Determinants of Health (SDoH) play an integral role in health outcomes across the cancer care continuum. Despite growing recognition of SDoH in healthcare, gaps exist in systematically identifying associated social risks and needs. Insights from multiple stakeholders are necessary to optimize integration of SDoH assessments in care delivery. This study examined the impact of SDoH on lung cancer care from the perspectives of key stakeholders, including family caregivers (FCGs), providers, and healthcare system administrators, all pivotal members in care delivery and decision-making. Methods:This qualitative study was conducted at a comprehensive cancer center. Participants were interviewed regarding the integration of SDoH assessments into cancer care. Conventional content analysis was used to generate codes and themes from these key informant interviews. SDoH information were collected using the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE) survey. Descriptive statistics were conducted for FCGs, and data were summarized using counts and percentages. Results:FCGs (n = 13) were predominantly non-Hispanic White females ages 60-68; other participants were five providers, (a nurse practitioner, three thoracic surgeons), and two administrators. Six themes and 19 sub-themes emerged. Participants had diverse knowledge across SDoH domains and suggested a variety of strategies for reducing caregiving burden. Three themes informed provider and administrator perspectives on the importance of integrating SDoH assessments into care delivery, with electronic health record (EHR) systems using interdisciplinary approaches that include FCG perspectives. Integrating SDoH into routine care was regarded as particularly complex in the context of lung cancer surgery, where the clinical focus is mostly on patient survival. Discussion:Addressing SDoH in cancer care delivery is complex yet essential. Systematic documentation, leveraging EHR systems, and interdisciplinary workflows are necessary to advance these efforts.

Importance:Health-related social needs (HRSNs) may impede colorectal cancer (CRC) screening among US adults, yet population-based evidence on these associations remains limited. Objective:To examine associations between HRSNs and CRC screening uptake overall and by age group among US adults. Design, Setting, and Participants:This cross-sectional study used data from the 2023 National Health Interview Survey. Participants were US civilian, noninstitutionalized adults aged 45 to 75 years eligible for CRC screening. Age-stratified analyses were conducted for adults aged 45 to 49 years, 50 to 64 years, and 65 to 75 years. Data analysis was performed from April 2025 to February 2026. Exposures:Self-reported HRSNs, including housing instability, food insecurity, transportation barriers, and number of unmet needs. Main Outcomes and Measures:The primary outcome was being up to date with CRC screening according to US Preventive Services Task Force recommendations. Survey-weighted logistic regression models estimated adjusted odds ratios (aORs) and 95% CIs overall and by age group. Results:The analytic sample included 14 528 adults aged 45 to 75 years, and most participants were aged 50 to 64 years (6940 individuals [52.42%]), female (7788 individuals [51.36%]), insured (13 750 participants [94.07%]), and reported no unmet HRSNs (12 370 participants [85.40%]). Overall, 2158 adults (14.60%) reported at least 1 unmet HRSN. The proportion up to date with CRC screening was 63.91% (9758 adults) overall and increased with age, from 31.01% (586 adults) among adults aged 45 to 49 years to 64.24% (4539 adults) among those aged 50 to 64 years, and 80.85% (4633 adults) among those aged 65 to 75 years. In adjusted models, housing instability (aOR, 0.82; 95% CI, 0.67-0.99) and transportation barriers (aOR, 0.78; 95% CI, 0.64-0.95) were associated with lower odds of being up to date with CRC screening. Screening odds declined with increasing number of unmet HRSNs, including among adults reporting 1 unmet need (aOR, 0.84; 95% CI, 0.72-0.98). Associations were most pronounced among adults aged 50 to 64 years, among whom housing instability (aOR, 0.77; 95% CI, 0.61-0.97), transportation barriers (aOR, 0.71; 95% CI, 0.56-0.91), and reporting 1 HRSN (aOR, 0.80; 95% CI, 0.66-0.97) were associated with lower odds of being up to date with screening. Conclusions and Relevance:In this cross-sectional study, unmet HRSNs were associated with lower CRC screening uptake, particularly among adults aged 50 to 64 years. Addressing HRSNs may support age-specific strategies to improve CRC screening.

BackgroundPatient portals integrated within electronic health records (EHRs) offer a scalable strategy to promote colorectal cancer (CRC) screening by providing access to education, appointment scheduling, screening reminders, and enhanced communication. However, little is known about how patients and personnel in Federally Qualified Health Centers (FQHCs) engage with these tools to support CRC prevention.MethodsThis convergent mixed-methods study assessed barriers, facilitators, and recommendations related to patient portal use and CRC screening promotion in three FQHCs in the Midwest. Surveys and semi-structured interviews were guided by the Consolidated Framework for Implementation Research (CFIR) and the Technology Acceptance Model (TAM). Eligible participants included patients aged 45-75 and personnel engaged in patient care or portal use.ResultsSeventeen patients and 17 personnel completed surveys and interviews. Most patients (74%) and personnel (71%) found the portal easy to use, and 79% of patients believed it would support cancer screening scheduling. Nearly all personnel (94%) supported portal implementation and were willing to promote CRC screening through it. Identified facilitators included accessible design, embedded education, and alignment with clinical workflows. Barriers included limited access, low digital literacy, and competing staff demands. Participants offered strategies to improve usability, promote culturally relevant content, and deliver preparatory education via the portal. Feedback on a digital CRC screening video suggested strong motivation to screen and support for future integration into portal workflows.ConclusionPatient portals are feasible and acceptable tools for increasing CRC screening in FQHCs. Implementation strategies addressing access, literacy, and content relevance are needed to optimize portal-based interventions.

OBJECTIVE:Uterine cancer is one of the few malignancies in the United States with rising incidence and mortality. Although racial and ethnic disparities in cancer-specific mortality are well documented, less is known about disparities in deaths from non-cancer causes. We examined temporal trends in racial and ethnic disparities in cancer-specific and other-cause mortality among patients with uterine cancer. METHODS:We identified uterine cancer cases (age ≥18 years) diagnosed between 2000 and 2019 from the Surveillance, Epidemiology, and End Results (SEER) Program, including non-Hispanic Asian, non-Hispanic Black, Hispanic, and non-Hispanic White patients. Diagnosis year was grouped into five-year periods and we ran period-stratified Cox proportional hazards models for associations between race/ethnicity and cancer-specific and other-cause mortality. Temporal trends were assessed using interaction terms between race/ethnicity and time period. RESULTS:Among 171,554 patients (mean age 61.3 years), Black patients experienced higher cancer-specific and other-cause mortality than White patients across all periods (p-interaction<0.0001 for both). While Black-White disparities in cancer-specific mortality varied over time, disparities in other-cause mortality increased. Asian patients initially had lower cancer-specific and other-cause mortality than White patients, but these differences attenuated over time. Hispanic patients had similar cancer-specific mortality as White patients but persistently worse other-cause mortality. CONCLUSIONS:Disparities in uterine cancer outcomes persist, with widening gaps in other-cause mortality among Black patients. These findings underscore the need for clinical strategies that integrate high-quality oncologic care with management of comorbid conditions to reduce inequities in outcomes.

Background The proportion of people living in unaffordable housing in the U.S. has grown, and studies have documented a relationship between housing cost burden and poor cardiovascular health. We investigated the association between severe housing cost burden (SHCB) and premature mortality due to cardiovascular disease (CVD) and its subtypes overall and by sex. We further evaluated whether Medicaid expansion status moderated the association between SHCB and premature CVD mortality. Methods We linked county-level SHCB data from the 2016–2020 American Community Survey with mortality data ascertained from national death certificate data. SHCB was measured as the percentage of households that spend ≥50 % of their income on housing and was categorized into distribution-based quintiles (1=lowest and 5=highest). States were classified based on Medicaid expansion status (expanded, late expanded, non-expanded). Multilevel-linear mixed models, adjusting for confounders, were used to estimate the adjusted rate ratios (aRR) for the association between SHCB and premature CVD mortality. Results The highest SHCB quintile, compared to the lowest, had a 15 % higher premature CVD mortality rate (aRR=1.15; 95 %CI 1.06–1.24). Among men, the highest quintile of SHCB had a higher premature mortality rate due to ischemic heart disease (aRR=1.09; 95 %CI 1.01–1.17) and stroke (aRR=1.19; 95 %CI 1.06–1.32) compared with the lowest quintile. Compared to Medicaid expanded states, non-Medicaid expanded states had higher rates of premature CVD mortality for each SHCB quintile (Quintile 5: aRR=1.19; 95 %CI 1.02–1.36). Conclusion Our findings suggest counties with greater SHCB, especially if situated within a non-Medicaid expansion state, have higher rates of premature CVD mortality.

INTRODUCTION:Non-Hispanic Black (Black) colorectal cancer (CRC) patients have a higher risk of mortality than most other racial/ethnic groups. Limited studies examine the contribution of socioeconomic (SES), clinicopathologic, or treatment variations to mortality disparities. This retrospective cohort investigation examined the extent to which SES, clinicopathologic, and treatment factors explain racial/ethnic differences in CRC mortality. METHODS:We studied 146,515 individuals, 18+ years old, with a confirmed diagnosis of CRC within 2010-2017, identified from the Surveillance, Epidemiology, and End Results (SEER) database. We performed Cox regression analyses to examine the association of race and ethnicity, surgery type, and tumor site with all-cause mortality and CRC-specific mortality. We then performed mediation analysis to quantify the extent to which mortality differences were mediated by SES, clinicopathologic, and treatment factors. RESULTS:Black patients had a significantly higher hazard of all-cause mortality than non-Hispanic White (White) patients. The White versus Black patients' comparison demonstrated that variations in SES and clinicopathologic factors significantly explained 46.63% (indirect effect HR: 0.92, 95% CI 0.91-0.93) and 10.87% (indirect effect HR: 0.98, 95% CI 0.97-0.99) of the excess all-cause mortality among Black patients, respectively. The Hispanic versus Black comparisons identified SES as the most influential mediator, explaining 19.68% of the excess all-cause mortality. The proportions mediating for CRC-specific mortality showed comparable outcomes to all-cause mortality. CONCLUSION:Black patients had a greater risk for all-cause mortality and CRC-specific mortality attributed to SES and clinicopathologic variations compared to other racial/ethnic groups. Future studies should investigate equity in healthcare through interventions addressing SES-related disparities.

Social Determinants of Health (SDoH) significantly influence outcomes across the cancer care continuum. However, systematic identification and integration of social risk factors into care remain limited. Understanding the perspectives of key stakeholders is essential to inform effective SDoH integration in lung cancer surgery. This qualitative study was embedded within a larger investigation of family caregivers (FCGs) and patients undergoing lung cancer surgery at a National Cancer Institute-designated center in Southern California. Semi-structured interviews were conducted with FCGs, healthcare providers, and system/healthcare administrators to explore their views on SDoH and its role in cancer care. Data were analyzed using conventional content analysis. Themes were developed through a collaborative coding and review process, supported by existing literature and expert input to ensure accurate interpretation. Any differences in coding were resolved through discussion, and descriptive statistics were used to summarize caregiver demographics. FCG participants (n=13) were primarily non-Hispanic White females, aged 60–68 years. We identified six major themes, and 19 sub-themes related to SDoH and caregiving burden. Four providers and two administrators (including thoracic surgeons, a nurse practitioner, a public health administrator, and a nurse scientist) emphasized the need for electronic health record (EHR)-based SDoH documentation, interdisciplinary collaboration, and recognition of FCGs as integral to care delivery. Integrating SDoH into lung cancer surgery intake and follow-up care was viewed as particularly challenging due to the clinical emphasis on survival. Given the focus on patient survival, the healthcare system should broaden its approach by integrating SDoH into lung cancer care. This shift toward coordinated, interdisciplinary care is essential for supporting long-term survival. Stakeholder insights highlight the need for systematic documentation, EHR integration, and comprehensive approaches to address social needs and improve outcomes. Dede K. Teteh-Brooks, Madeleine Love, Aldenise P. Ewing, Betty Ferrell, Oluwatimilehin Okunowo, Audrey Shin, Loretta Erhunmwunsee, Dan Raz, Rick Kittles, Jae Y. Kim, Virginia Sun. Lived experiences and systemic barriers in lung cancer surgery: Perspectives from caregivers, clinicians, and administrators on social determinants of health [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr A004.

Introduction: There are consistent data demonstrating socioeconomic status (SES) is associated with cancer survivorship among older adults, but research on the relationship between area-level SES and risk of premature mortality from cancer remains not well understood. This study investigated the association between county-level SES and premature mortality from cancer. Methods: Demographic characteristics and causes of death were ascertained from the national death certificate data for years 2016-2020. Premature cancer death was defined as cancer mortality between ages 25-64. County SES was calculated using the Yost Index and categorized into distribution-based quintiles (1 =lowest SES, 5=highest SES). To calculate the mortality-adjusted rate ratios (aRR) and corresponding 95 % confidence intervals (95 %CI) for the associations between county SES and cancer, we performed multivariable linear mixed models, adjusting for confounders. Results: A total of 3143 counties were included. The age-adjusted mortality rates of all cancers combined were 107.6, 98.4, 88.6, 81.1, and 66.7 per 100,000 population for the 5 SES quintiles, respectively. Compared with high SES counties, low SES counties had a 58 % greater premature cancer mortality rate (aRRquintile 1 vs.5 =1.58, 95 %CI: 1.55-1.60). Similar associations were observed when stratified by sex, though risk was greatest among men ([aRRwomen=1.48, 95 %CI: 1.45-1.52]; [aRRmen=1.66, 95 %CI: 1.62-1.70]). Among leading cancer types, the association was greatest for lung cancer mortality for the lowest SES counties (aRR=2.03; 95 %CI: 1.98-2.08). Conclusion: Our findings demonstrate that lower SES counties are at greater risk of premature mortality from cancer. Place-based interventions should target the socioeconomic environment across the cancer control continuum.

Background: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. Early detection via routine CRC screening can significantly lower risks for CRC-specific morbidity and mortality. Public health initiatives between 2000 and 2015 nearly doubled CRC screening rates for some US adults. However, screening rates remain lowest for adults aged 45-49 years (20%), patients of safety net health care facilities (42%), adults without insurance (44%), and other subgroups compared with national averages (72%). Given the evolving landscape of digital health care and trends in web-based health information-seeking behaviors, leveraging online medical record (OMR) systems may be an underutilized resource to promote CRC screening utilization. Recognizing trends in OMR usage and patient demographics may enhance digital inclusion-a key social determinant of health-and support equitable web-based interventions aimed at boosting CRC screening across diverse populations. Objective: This study examined the association of accessing an OMR with CRC screening utilization and corresponding sociodemographic characteristics of US adults. Methods: In 2023, we conducted a secondary data analysis using a pooled, weighted sample from Health Information National Trends Survey (HINTS) 5 cycles, 2, 3, and 4 (2018-2020), a nationally representative survey assessing how US adults access and use health-related information. We analyzed the association between sociodemographic characteristics, medical conditions, OMR access, and CRC screening behaviors via logistic regression. Results: The sample included adults aged 45-75 years (N=5143). The mean age was 59 (SD 8) years for those who reported CRC screening and 52 (SD 6) years for those never screened. Nearly 70% (4029/5143) of participants reported CRC screening and 52% (2707/5143) reported OMR access in the past year. Adjusted odds of CRC screening were higher among non-Hispanic African American or Black adults than among non-Hispanic White adults (odds ratio [OR] 1.76, 95% CI 1.22-2.53), adults who accessed an OMR (OR 1.89, 95% CI 1.45-2.46), older individuals (OR 1.18, 95% CI 1.16-1.21), the insured (OR 3.69, 95% CI 2.34-5.82), and those with a professional or graduate degree versus those with a high school diploma or less (OR 2.65, 95% CI 1.28-5.47). Individuals aged 65-75 years were significantly more likely (P<.001) to be screened (1687/1831, 91%) than those aged 45-49 years (190/610, 29%). Conclusions: Promoting OMR access, especially among the most disadvantaged Americans, may assist in reaching national screening goals. Emphasis should be placed on the mutability of OMR use compared with most other statistically significant associations with CRC screening behaviors. OMR access provides an intervenable means of promoting CRC education and screening, especially among those facing structural barriers to cancer diagnoses and care. Future research should focus on tailored and accessible interventions that expand OMR access, particularly for younger populations.

Background: In the United States, African/Black American (henceforth Black) men face significantly higher mortality rates from colorectal cancer (CRC) compared to other gender, racial, and ethnic groups. Although CRC is preventable and treatable with early detection, screening rates among Black men remain low. This study aimed to synthesize existing literature on the barriers and facilitators (determinants) of CRC screening to offer guidance to primary care teams in their efforts to improve screening uptake. Methods: We performed a comprehensive systematic review of full-text, peer-reviewed studies published in English to explore the various determinants influencing CRC screening among Black men. Using key terms like “Black or African American,” “male,” and “colorectal cancer screening,” we searched databases including PubMed, PsychInfo, CINAHL, and Embase, published between 2009 and 2022. Findings: The search identified 1235 articles, with 54 meeting the inclusion criteria. Most studies were cross-sectional, examining determinants across the socioecological system. Key barriers included a lack of CRC screening knowledge, poor patient-provider communication, lack of access to screening, and medical mistrust stemming from systemic racism. Significant facilitators included aging, receiving a provider recommendation, having social support, and effective culturally appropriate outreach strategies. Conclusions: Key themes and significant findings from the review provide actionable strategies for primary care teams. These include enhancing knowledge about CRC screening within the patient population, improving patient-provider interactions, and reducing barriers to accessing screening. Future research should aim to develop culturally appropriate and collaborative preventive care strategies to improve screening adherence and CRC-related outcomes.

African American/Black (henceforth Black) men face disproportionate risks of morbidity and mortality from both cardiovascular disease (CVD) and colorectal cancer (CRC). The American Heart Association's Life's Simple 7 (LS7) tool was designed to examine predictors of CVD with included behaviors also linked to CRC risk (i.e., smoking status, weight, diet, and physical activity). However, no studies have combined LS7 assessment alongside CRC screening history, which serves as a proxy for assessing CRC risk, in Black men. In this study, Black men aged 45-75 participating in annual community wellness events were screened for 6 of 7 LS7 measures (excluding diet, LS6) and self-reported CRC screening. Analyses conducted using R 4.0.5. revealed that Black men (N = 680), with an average age of 57.3 years (SD = 7.5), reported poor (39.7%), intermediate (34.6%), or ideal (25.7%) LS6 scores with higher scores corresponding to lower risk for CVD. However, for every 1-point increase in LS6 scores (0-6), there was a 26% lower odds of reported CRC screening (p = .001). In the fully adjusted model, men with 4+ ideal LS6 behaviors had a 60% lower odds of self-reported CRC screening compared to those with two ideal LS6 behaviors (p < .001). These findings underscore the need for culturally relevant interventions for Black men across all levels of cardiovascular health (CVH) to increase CRC screening uptake.

BackgroundDeveloping an understanding of the negative impact of discrimination is critical when examining the suicidality of Black young adults in the US. Suicide rates among Black young adults have increased at alarming rates. One of the reasons for this increase is the disparities related to access to mental health services, which has long-term health consequences. This study addresses a significant gap in the literature by examining associations between experiences of everyday discrimination, attitudes towards mental health help-seeking attitudes, on the outcomes suicide ideation, planning to die by suicide, and suicide attempts.MethodsThe data came from a national study of the experiences of Black young adults regarding mental, physical, and sexual health. Participants were recruited from across the Midwestern region of the United States through Qualtrics Panels, an online survey delivery service used to recruit study participants. The total sample for this study was N = 362, and the average age of the sample was 21 (SD: 1.96). We used a logistic regression analysis to examine the role of everyday discrimination, mental health support-seeking attitudes, and covariates on the outcomes: suicide ideation, planning to die by committing suicide, and suicide attempts.ResultsBlack young adults with positive mental health help-seeking attitudes were 34% less likely to attempt suicide (OR = 0.66; 95% CI: 0.46, 0.96) and 35% less likely to experience suicide ideation (OR = 0.65; 95% CI: 0.47, 0.89). However, those young adults who experienced discrimination daily were more likely to report having attempted suicide (OR = 1.70; 95% CI: 1.34, 2.15).ConclusionsOur findings offer valuable insights into the complex interplay between experiences of discrimination, attitudes toward seeking mental health support, and suicidal behaviors. However, our research also underscores how experiences of discrimination can significantly exacerbate feelings of isolation, hopelessness, and inadequacy, further contributing to suicidal behaviors in this population. By promoting positive mental health help-seeking behaviors, actively addressing discrimination, and applying an intersectional approach to suicide prevention efforts, we can take significant strides towards building a more supportive and inclusive society. This approach aims to empower individuals to seek help, reduce the risk of suicidal behaviors, and create a more welcoming environment for all members of our community.

Abstract Introduction: The fraction of people living in unaffordable housing in the U.S. has grown, and prior studies have documented a relationship between housing cost burden and worsening health. Medicaid expansion has been suggested to improve housing financial stability by reducing health care costs and improving access to preventative care. However, the role of expanded access to Medicaid on the relationship between housing cost burden and cancer mortality remains poorly understood. We investigated the relationship between county-level severe housing cost burden and premature cancer mortality by state Medicaid expansion status for all cancers and leading sites. Methods: This ecological study used county-level data from 2016-2020 American Community Survey linked with county-level mortality data. Severe housing cost burden measured by percentage of households within a county that spend ≥50% of their income on housing categorized into quintiles (1=lowest, 5=highest) and state Medicaid expansion status (expanded and non-expanded). Age-adjusted cancer mortality rates and adjusted-mortality rate ratio (aRR) were estimated by sex. Results: Across quintiles of county-level severe housing cost burden, age-adjusted cancer mortality rates were largely greater in non-Medicaid expanded states than Medicaid expanded states among women and men. Among counties in the lowest quintile of severe housing cost burden, rates for overall cancer mortality in women were 9% (aRR=1.09; 95%CI 1.05-1.14) higher in non-Medicaid expanded states compared with expanded states. Additionally, among the third quintile of severe housing cost burden, colorectal cancer mortality rate was 8% higher (aRR=1.08; 95%CI 1.02-1.14) in non-Medicaid expanded states. Among men in the lowest quintile of severe housing cost burden, overall cancer mortality rates were 5% (aRR=1.05; 95%CI 1.02-1.09) higher in non-Medicaid expanded states than Medicaid expanded states. Further, among men in counties in the highest quintile of severe housing cost burden, colorectal cancer mortality rate was 8% higher (aRR=1.08; 95%CI 1.05-1.12) and lung cancer mortality was 13% higher (aRR=1.13; 95%CI 1.10-1.15) in non-Medicaid expanded states compared with expanded states. Conclusions: Counties with a lower fraction of households experiencing severe housing cost burden had greater premature cancer death rates within non-Medicaid expanded states than Medicaid expanded states. However, among men rates were also elevated in non-Medicaid expanded states in counties with the greatest severe housing cost burden. Citation Format: Wayne R. Lawrence, Neal D. Freedman, Jennifer K. McGee-Avila, Lee Mason, Yingxi Chen, Aldenise P. Ewing, Meredith S. Shiels. Severe housing cost burden and premature cancer mortality by state Medicaid expansion status [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 801.

Unaffordable housing has been associated with poor health. We investigated the relationship between severe housing cost burden and premature cancer mortality (death before 65 years of age) overall and by Medicaid expansion status. County-level severe housing cost burden was measured by the percentage of households that spend 50% or more of their income on housing. States were classified on the basis of Medicaid expansion status (expanded, late-expanded, nonexpanded). Mortality-adjusted rate ratios were estimated by cancer type across severe housing cost burden quintiles. Compared with the lowest quintile of severe housing cost burden, counties in the highest quintile had a 5% greater cancer mortality rate (mortality-adjusted rate ratio = 1.05, 95% confidence interval = 1.01 to 1.08). Within each severe housing cost burden quintile, cancer mortality rates were greater in states that did not expand Medicaid, though this association was significant only in the fourth quintile (mortality-adjusted rate ratio = 1.08, 95% confidence interval = 1.03 to 1.13). Our findings demonstrate that counties with greater severe housing cost burden had higher premature cancer death rates, and rates are potentially greater in non-Medicaid-expanded states than Medicaid-expanded states.

Abstract Purpose Alabama has the 7th highest cancer mortality in the US. The University of Alabama at Birmingham O’Neal Comprehensive Cancer Center—the only NCI-designated comprehensive cancer center in the state—endeavors to reduce cancer mortality and burden. For 25 years, its Office of Community Outreach and Engagement (OCOE) has applied a community health worker (CHW) outreach and engagement model for cancer awareness, navigation to screening and healthy lifestyle promotion. OCOE hired and trained CHWs to provide services in counties with highest cancer burden. CHW presence fluctuated over time due to grant-funding and other extraneous events. This study evaluates the association of CHW presence with cancer screening and lifestyle-related outcomes. Methods We utilized latest CDC PLACES data (drawn from 2018 and 2020 Behavioral Risk Factor Surveillance System) which provides model-based, population-level age-adjusted prevalence estimates of county-level cancer screening (breast, cervical, colon) and lifestyle outcomes (physical inactivity, obesity, smoking). We evaluated change in rates over time between counties with and without CHW presence using linear mixed effects models. Results Compared to counties without CHW presence, those with CHW presence in 2020 had 0.7% higher mammography rate in 2018 (95% CI: -0.8, 2.3) and 0% difference in mammography rate per year change (95% CI: -0.6, 0.7); counties with CHW presence in both years had 2.8% higher mammography rate (95% CI: 1.1, 4.6) and 0.2% faster increase in mammography rate per year (95% CI: -0.5, 1.0). Counties with CHW presence in both 2018 and 2020 had 1.8% lower rate of colon cancer screening in 2018 (95% CI: -3.6, 0.02) and 1.3% increase in colon cancer screening per year (95% CI: 0.5, 2.1). Counties with CHW presence in 2020 had 1% higher physical inactivity rate in 2018 (95% CI: -2.3, 4.3) and 0.3% faster decrease in physical inactivity rate per year (95% CI: -1.0, 0.4); counties with CHW presence in both years had 3.6% higher physical inactivity rate in 2018 and 0.2% faster decrease in physical inactivity rate per year (95% CI: -0.8, 0.5). Counties with CHW presence in 2020 only had 1.8% higher obesity rate in 2018 (95% CI: -1.7, 5.2) and 0.9% faster decline in obesity rate per year (95% CI: -2.2, 0.4); counties with CHW presence in both years had 5.1% higher obesity rate in 2018 (95% CI: 1.9, 8.3) and 0.3% faster decline in obesity rate per year (95% CI: -1.6, 0.9). There were no statistically significant differences for cervical cancer screening or smoking. Conclusion The OCOE CHW model provided access, education and empowerment for AL residents to obtain cancer screenings and participate in healthy lifestyle behaviors. CHW presence (particularly sustained presence over time) was associated with improved mammography and colon cancer screening, reduced physical inactivity and reduced obesity. Further study of CHW presence and these outcomes during and post COVID-19 is ongoing. Expansion of the CHW model across the entire state is a priority to reduce cancer mortality among Alabamians. Citation Format: Mackenzie E. Fowler, Claudia Hardy, Silvia Gisiger-Camata, Francine Walton, Rochelle Wallace, Tara Bowman, Aldenise P. Ewing, Timiya S. Nolan. Bridging gaps in cancer care: Evaluating community health worker presence in Alabama on rates of cancer screening and lifestyle-related outcomes [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B060.

Overall colorectal cancer (CRC) incidence and mortality have been decreasing for several decades; however, since the early 1990s CRC incidence rates have nearly doubled among adults aged under 50 years. This study pilot-tested a community-based mass-media campaign aimed at improving knowledge and awareness of early-onset CRC in this population. The campaign (#CRCandMe) was deployed from June to September 2023 in Utah and Wisconsin. To evaluate its success (reach) and inform future campaigns, key performance indicators were defined (e.g., impressions, website traffic). To evaluate change in knowledge in the target population, the knowledge and awareness of participants recruited via consumer panels was assessed at baseline (n=235) and follow-up (n=161). The number of correct answers for each of seven knowledge items was calculated at baseline (pre-intervention) and follow-up (post-intervention). McNemar's test was employed to assess significant differences in the seven knowledge items between the two timepoints. The campaign delivered over 26.7 million impressions and nearly 43,000 clicks. A 15-second video ad received 221,985 plays, with 57,270 users watching to completion. Pre-survey results revealed that while 74% of participants were able to correctly identify CRC signs, only 18% could identify risk factors. Knowledge scores slightly improved from baseline to follow-up, with statistically significance for the question related to CRC signs (P=0.0004). This study demonstrated wide reach and may inform future larger-scale interventions and public health initiatives aimed at reducing CRC incidence and improving health outcomes for at-risk adults aged under 50 years.